Partnering for health in Zanzibar

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For many of us, the name Zanzibar conjures visions of an idyllic holiday destination, encouraged by its paradisiacal landscapes and rich cultural tapestry. Yet, this coral archipelago, nestled in the Indian Ocean, 23 miles off the eastern coast of Tanzania has experienced its fair share of challenges over the past decade; from climate change and political instability to economic difficulties due to high unemployment and the pandemic's effect on the country’s tourist trade on which it greatly depends.

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It doesn’t take long when investigating the needs of Zanzibar’s population to discover a complex and nuanced healthcare landscape, reflective of the broader challenges facing many regions across the African continent. In Zanzibar, the pursuit of health and well-being is a journey marked by resilience, innovation, and persistent obstacles.

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The intention of the Zanzibar Ministry of Health to strengthen healthcare infrastructure is certainly there. The current policy issued concerning its public health system requires all services to be provided free of charge to patients, but the reality looks very different. Extremely limited resources result in only 3% of the GDP allocated to health – lower than the WHO recommended minimum of 5% to achieve universal health coverage – the needs of the population significantly outweigh the ability to deliver on this policy.

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This results in high rates of out-of-pocket expenditure for patients – in a country where 26% of the population lives in poverty – when health facilities don't have the supplies needed and the doctor-to-population ratio is just 1 to every 6,000 people, six times the recommended WHO ratio.

A pressured health system

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The current healthcare issue is most stark when considering the high burden of non-communicable diseases (NCDs) in Zanzibar, particularly among the adult population. The most prevalent of these is hypertension. Also known as high blood pressure, hypertension is a condition in which blood vessels have consistently raised pressure. This severe condition can increase the risk of heart, brain, and kidney disease, as well as other diseases. It has become the leading cause of hospital admission and death in adults across Zanzibar.

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“Hypertension is such an issue for the community because of diet and lifestyle,” Dr Aisha runs the hypertension clinic at Makunduchi Hospital, located in the south of Zanzibar's largest island, Unguja. “It is common [due to] foods with high salt or fat content like coconut oil.”

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“Hypertension mostly affects people from 40 years onwards,” Kazija, a nurse in Makunduchi Hospital’s hypertension clinic told us. “Women are more affected than men. Each and every day, cases are increasing.”

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In fact, the situation is of national concern. In a 2020 survey conducted by the scientific journal BMC Public Health, it was estimated that at least 33.5% of the adult population in Zanzibar has hypertension. Without consistent access to treatment, hypertension will lead to serious heart complications and the risk of stroke.

I thank God we can often get part of the needed prescription but if I am told to go and buy the rest, with no money, what will I do?

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– Imani, a hypertension patient living in Unguja –

The cost of a healthy life

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Yet within the current health context of Zanzibar, patients living with hypertension have no guarantee that their treatment will be available, or if it is, whether they can afford it.

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Imani sits outside her home with her grandchildren

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“I suffer from high blood pressure and have to go to the hospital to be treated,” Imani lives in Unguja with her husband, children and grandchildren. “At first, I had severe flu, so I went to the hospital, and I was told to go to the blood pressure department. It was very high.

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We get the best service in terms of doctors… but there have been emergencies where I have needed two types of drugs, and one might be out of stock. In these cases, I have to go and buy the missing one. When I had to pay for medicines, many times you would get just some of them, or even none at all. I thank God we can often get part of the needed prescription but if I am told to go and buy the rest, with no money, what will I do? l don't have money and l don't have someone to help.”

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Meet Aziza waiting in the hypertension clinic for her appointment

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Aziza, aged 46, lives on her small farm in a small village in Unguja with her two daughters aged seven and 13.

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“Three years ago I was at a wedding and I felt numbness in my face and mouth. I didn’t know what was happening so I went to the hospital. They admitted me for a potential stroke and I stayed for two days. They tested my blood pressure and it was high. They gave me some treatment and I started coming to the clinic, initially every two months but now monthly. Sometimes I come more regularly when my blood pressure is high or if I don’t have any medication left.

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Ever since I got the diagnosis, I have been scared, and I’m trying my best to take the medicines so my blood pressure doesn’t spike.

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Usually, the medicine is available here at the hospital, but other times, it isn’t and I have to buy it myself at a private pharmacy. Sometimes I have the money to buy it, sometimes I don’t. This is a challenge for me as a single mother, I can’t afford it. Sometimes I have to choose between feeding my family and protecting my health.”

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This is an issue Dr Asha regularly witnesses with the patients she serves: “I write the prescription for the patient to collect it from the hospital pharmacy. Sometimes, the medicine is available; sometimes, it is not. It depends on the type of medicine, but most of the time, patients cannot pay and come back to the clinic another day with very high blood pressure.”

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Hope for a better, healthier future

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A significant factor contributing to the burden of hypertension on the health system is complications associated with unmanaged conditions; this can be due to multiple factors, including lack of screening and late diagnosis, but it is particularly linked to the availability of medicine, a common occurrence in Dr Asha’s line of work: “If they can’t get the medicine, some patients start and stop their treatment causing their hypertension to increase, and this is dangerous. Sometimes, I have seen patients who then end up coming into the emergency department with strokes and heart attacks.

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Of the 33.5% of the population living with hypertension, just 12.7% of those are on treatment, and of those, only 7.8% with adequate blood pressure control.

Seeing this urgent need for improved awareness, access to healthcare services, and medicines for patients to adhere to treatment cycles, IHP joined with health NGO Health Improvement Project Zanzibar (HIPZ), which has been serving communities across Zanzibar for 15 years. Our partnership with HIPZ helps provide consistent access to medicine to manage high blood pressure to Makunduchi Hospital, and also Kivunge Hospital in the north, as well as smaller health initiatives across Unguja island, all free of charge to the patient – giving patients hope for a better, healthier future.

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Watch the video to see how our partnership with HIPZ is making a difference to patients like Mosi, he gained reliable access to his hypertension medication through our shipments to Makunduchi Hospital, free of charge. “The way my life is now,” he says. “I’m very grateful.”

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Continuous, reliable sources of essential NCD medications are vital for ensuring we can continue to lift the burdens that weigh on much of the adult population in Zanzibar. Your support will mean a higher quality of life and stability for not only hypertension patients but also their families as the financial worries over the cost of medicine are reversed with the free healthcare we provide. Please join us in continuing to expand this vital work across Zanzibar

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